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Introduction

Demand for critical care services is increasing yet a comprehensive understanding
of how critical care nurses - the largest group of ICU direct care providers - impact
outcomes remains unclear. The purpose of this study was to determine how critical
care nurse education (hospital proportion of bachelor's prepared ICU nurses) and ICU
work environment influenced 30-day mortality of mechanically ventilated older adults.

Methods

A multi-state cross-sectional nurse survey was linked to hospital administrative data
and Medicare claims (2006 to 2008). The final sample included 55,159 mechanically
ventilated older adults in 303 hospitals. Logistic regression modeling was employed
to jointly assess the relationship of critical care nurse education, work environment
and staffing on 30-day mortality while adjusting for hospital and patient characteristics
and accounting for clustering.

Results

A 10% increase in the proportion of ICU nurses with a bachelor's degree or higher
was associated with 2% lower odds of death while controlling for patient and hospital
characteristics. Patients cared for in better work environments experienced 11% lower
odds of risk-adjusted death than those cared for in poorer ICU work environments.

Conclusion

Patients cared for in hospitals with a greater proportion of bachelor's prepared ICU
nurses and in better ICU work environments experienced significantly lower odds of
death. As the demand for critical care services increases, attention to the education
level of ICU nurses and ICU work environment may be warranted to optimize currently
available resources and potentially yield better outcomes.